Oesophageal variceal banding is an endoscopic procedure that closes dilated veins in the lower oesophagus by placing small elastic bands on them. A device carrying several bands is mounted on the tip of the endoscope, the dilated vein is suctioned into it, and a band is released to strangle its base so that blood flow stops, the vein scars and it closes over the following days. It is done under sedation and may be performed as an emergency to stop active bleeding, or electively to prevent an anticipated bleed. Varices are not a disease of the oesophagus itself; they are a consequence of raised pressure in the portal vein, most often caused by cirrhosis of the liver. When blood cannot pass easily through the liver it seeks alternative routes, so thin-walled veins in the lower oesophagus and upper stomach dilate and their walls become vulnerable to rupture. Variceal bleeding is a serious event that requires emergency care immediately, never observation at home. Go to the emergency department at once, without waiting for morning, if you vomit red blood or coffee-ground material, pass black tarry stools, feel dizzy, break into a cold sweat or faint, or have a racing pulse with pallor. These are signs of active variceal bleeding, and time is decisive. The limits must be stated with complete honesty. Banding closes only the veins that were banded. It does not treat cirrhosis, it does not lower portal pressure, and it does not prevent new varices from appearing, including varices in the stomach. This is why it is normally carried out over several sessions until visible varices are eradicated, followed by periodic surveillance endoscopy. It forms part of a plan that includes medication prescribed to reduce portal pressure, along with liver follow-up and treatment of the underlying cause, and it replaces none of these. Suitability, the number of sessions and the interval between them are determined by clinical assessment, the grade of the varices and liver status, not by reading an article. Complications are uncommon but real: an ulcer at a band site that can bleed, chest discomfort, transient difficulty swallowing, and stricture in a small number of cases.
Procedure steps
- 1
Assessing the liver and grading the varices
Liver status, liver function, blood count and clotting are reviewed, and it is established whether banding is being done urgently for active bleeding or electively for high-risk varices, with the accompanying drug plan set.
- 2
Stabilisation, sedation and readiness
In acute bleeding, intravenous fluids, support and medication are given as required before endoscopy, with sedation and airway protection arranged where needed; safety takes precedence over speed.
- 3
Identifying varices and suctioning the vein
The scope is introduced and the lower oesophagus and upper stomach are examined to map the varices and any signs of recent bleeding. The banding device is then apposed to the target vein, which is suctioned into the clear cap on the scope tip.
- 4
Deploying the bands
An elastic band is released onto the base of the vein, strangling it and arresting flow, and the step is repeated on several veins in the same session in the order the endoscopist chooses, then band position and haemostasis are confirmed.
- 5
Observation, eradication sessions and surveillance
You are observed for chest pain or recurrent bleeding, and further banding sessions are scheduled at intervals your doctor sets until the varices are eradicated, followed by periodic surveillance endoscopy alongside portal-pressure medication.
Before the procedure
For a planned banding session, fasting from food and fluids for the period the unit specifies is mandatory, because the procedure is done under sedation. Tell your doctor about all your medicines: blood thinners and anticoagulants, diuretics, liver medications, any beta-blocker prescribed to lower portal pressure, and painkillers, especially non-steroidal anti-inflammatory drugs and aspirin, which increase bleeding risk. Report any drug allergy. Give your full liver history: the cause of cirrhosis, any previous variceal bleed, earlier banding sessions, and any history of ascites or confusion, as all of these change the plan for the session and the monitoring afterwards. Avoid alcohol completely. Arrange an adult escort to take you home and stay with you, since driving is not allowed after sedation, and expect a possible overnight stay if banding was done for acute bleeding.
After the procedure
Expect mild chest discomfort, an awareness of something in the throat and temporary difficulty swallowing for several days; this is usual after banding. Follow the fluid then soft-diet instructions you are given, avoid dry bread, crisp foods, large pieces of meat and hard grains, which can dislodge the bands, chew well and drink with meals, and never swallow large tablets without enough water. Seek emergency care immediately for vomiting blood or coffee-ground material, black tarry stools, dizziness, fainting or cold sweats, severe chest pain or breathlessness, fever, or pain that markedly worsens on swallowing: bleeding from a band-site ulcer is an uncommon but recognised complication and can occur days after the session. Avoid alcohol and non-steroidal anti-inflammatory drugs. Most importantly, banding is not the end of treatment: keep taking your prescribed medication, attend the remaining banding sessions and your liver follow-up appointments, because without them the varices return.
Expected duration
Usually 20 to 40 minutes per session, with one to two hours of observation, and an inpatient stay when banding is performed for acute bleeding.
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